As reported in this local article, headlined "Judge Rebukes Arizona Walmart for Firing Employee With Medical-Marijuana Card," a federal court last week issued a notable ruling on behalf of a medical marijuana patient in Arizona. Here are the basics:

An Arizona Walmart location terminated an employee in 2016 who held a valid medical-marijuana card after a drug test came back positive. But now a federal judge has ruled that because Walmart could not prove the employee was impaired at work, the company violated the nondiscrimination provision in the Arizona Medical Marijuana Act.

In a significant decision that recognized a private right of action for employment discrimination under the AMMA, Arizona U.S. District Judge James A. Teilborg said last week that Walmart was not justified in firing the worker based on the company's idea that marijuana metabolites in her urine meant she must have been impaired at work.

Whitmire's attorney Joshua Carden, who runs a Scottsdale-based law firm, said Teilborg's decision is "the first of its kind in Arizona."

"No court has officially decided whether a private right-of-action exists under the Arizona Medical Marijuana Act, so that was a big part of the decision," Carden told Phoenix New Times on Tuesday.

Before she was fired, Carol Whitmire had worked at Walmart stores in Show Low and Taylor for about eight years. On May 21, 2016, while working as a customer service supervisor at the Taylor Walmart, a bag of ice fell on Whitmire's wrist while she was leveling the bags, according to the lawsuit. The injury led to an urgent care visit and a drug test, pursuant to Walmart policy. Whitmire’s urine tested positive for marijuana metabolites.

A medical-marijuana cardholder for approximately the last five years, Whitmire smokes marijuana before bed to treat her shoulder pain and arthritis, and as a sleep aid, according to court records. She says she never brought marijuana to work or reported to the job impaired.

After the wrist injury, Whitmire informed the Walmart human resources department and the urgent care clinic that she holds a medical-marijuana card. She continued working until July 4, when she was suspended as a result of the urine sample. Her manager fired Whitmire on July 22 because of the positive result of the drug test, the complaint says.

In March 2017, Whitmire filed a discrimination charge with the Equal Employment Opportunity Commission and the civil rights division of the Arizona Attorney General’s Office. Three months later, she sued Walmart in federal court in Phoenix, alleging wrongful termination and discrimination in violation of the AMMA, the Arizona Civil Rights Act, and Arizona worker's compensation law.

In his decision last week, first reported by Law360, Teilborg granted partial summary judgment to Whitmire for her claim of discrimination under the AMMA. The judge, however, denied Whitmire’s claims alleging discrimination under the Arizona Civil Rights Act and retaliatory termination under Arizona employment protection and worker’s compensation laws.

The court will make a decision regarding damages or Whitmire's potential reinstatement in May, her attorney said. Under the AMMA, it is illegal for an employer to discriminate in hiring or firing based on a patient's "positive drug test for marijuana components or metabolites, unless the patient used, possessed or was impaired by marijuana on the premises of the place of employment or during the hours of employment."

In court, Walmart denied wrongfully terminating or discriminating against Whitmire, and said the company's drug testing policy is lawful and protected under Arizona's Drug Testing of Employees Act (DTEA). But Teilborg wrote that in the absence of expert testimony establishing that Whitmire's drug test shows she was impaired at work because of marijuana she smoked the night before, Walmart "is unable to prove that Plaintiff’s drug screen gave it a ‘good faith basis’ to believe Plaintiff was impaired at work."

Walmart could not meet the burden of proving that the urine sample after the accident “sufficiently establishes the presence of metabolites or components of marijuana in a scientifically sufficient concentration to cause impairment,” the judge wrote.

The full 50+ page ruling in Whitmire v. Walmart is available at this link. As the press report notes, the key to the ruling is the patient protective language in the the Arizona Medical Marijuana Act. Consequently, this ruling does not provide protection to medical marijuana patients outside the state. But the ruling is still notable and another recent example of lower courts growing more comfortable recognizing and enforcing rights under state law on behalf of some marijuana users in some settings.

Though Ohio enacted its medical marijuana law, HB 523, way back in June 2016, the state took quite some time getting its rules and regulations and licenses in place to make the program operational. But starting about a month ago, a few medical marijuana dispensaries were open for business and a system for registering doctors and patients in the program has been operational for a few months.

This past week, the Ohio Medical Marijuana Control Program Advisory Committee had a meeting at which this powerpoint presentation was shared showing all sorts of interesting data about how this program is now operating. Though I do not think the data is all too dissimilar to what we see in other states recently bringing a medical marijuana programs on-line, I still found these early facts from these PPT slides notable:

Medical Marijuana Sales Figures (from January 16 – February 3, 2019) had total sales of $502,961, with total volume of 68.22 pounds

Total Patient Recommendations were 17,077, along with 472 Total Caregivers

Patients with Veteran Status were 1,284, with Indigent Status were 405, and with a Terminal Diagnosis were 83

10% of Registered patients are aged 18-29, 21% are aged 30-39, 22% are aged 40-49, 22% are aged 50-59, 19% are aged 60-69, and 6% are over 70

Registered patients have twenty-one different conditions, with the top five being Spinal cord disease or injury (998 patients), Cancer (1,082), Fibromyalgia (1,973), Post-traumatic stress disorder (2,622), and Pain that is either chronic and severe or intractable (10,910)

There are 374 active Certificates To Recommend (CTRs) among physicians, but only 177 physicians have so far issued recommendations for patients

The title of this post is the title of this short new "Viewpoint" piece authored by Keith Humphreys and Richard Saitz and published in the Journal of the American Medical Association. I recommend the full piece, and here are excerpts:

Recent state regulations (eg, in New York, Illinois) allow medical cannabis as a substitute for opioids for chronic pain and for addiction. Yet the evidence regarding safety, efficacy, and comparative effectiveness is at best equivocal for the former recommendation and strongly suggests the latter — substituting cannabis for opioid addiction treatments is potentially harmful. Neither recommendation meets the standards of rigor desirable for medical treatment decisions.

Recent systematic reviews identified low-strength evidence that plant-based cannabis preparations alleviate neuropathic pain and insufficient evidence for other types of pain. Studies tend to be of low methodological quality, involve small samples and short-follow-up periods, and do not address the most common causes of pain (eg, back pain). This description of evidence for efficacy of cannabis for chronic pain is similar to how efficacy studies of opioids for chronic pain have been described (except that the volume of evidence is greater for opioids with 96 trials identified in a recent systematic review).

The evidence that cannabis is an efficacious treatment for opioid use disorder is even weaker. To date, no prospective evidence, either from clinical trials or observational studies, has demonstrated any benefit of treating patients who have opioid addiction with cannabis.

Substituting cannabis for opioids is not the same as initiating opioid therapy. There are no randomized clinical trials of substituting cannabis for opioids in patients taking or misusing opioids for treatment of pain, or in patients with opioid addiction treated with methadone or buprenorphine. In addition to surveys of patients who use medical cannabis, the other types of studies prompting a move to cannabis to replace opioids are population-level reports stating that laws allowing medical cannabis use are followed by fewer opioid overdose deaths than expected. The methodological concern with such studies is that correlation is not causation. Many factors other than cannabis use may affect opioid overdose deaths, such as prescribing guidelines, opioid rescheduling, Good Samaritan laws, incarceration practices, and availability of evidence-based opioid use disorder treatment and naloxone....

For opioid use disorder, there is concern that the New York State Health Commissioner has defined opioid addiction to include people being treated with US Food and Drug Administration – approved, efficacious, opioid agonist medications, as a qualifying condition for medical cannabis. Methadone and buprenorphine treatment reduces illicit opioid use, blood-borne disease transmission, criminal activity, adverse birth outcomes, and mortality. Discontinuing such medications increases the risk of return to illicit opioid use, overdose, and death. The suggestion that patients should self-substitute a drug (ie, cannabis) that has not been subjected to a single clinical trial for opioid addiction is irresponsible and should be reconsidered....

Cannabis and cannabis-derived medications merit further research, and such scientific work will likely yield useful results. This does not mean that medical cannabis recommendations should be made without the evidence base demanded for other treatments. Evidence-based therapies are available. For chronic pain, there are numerous alternatives to opioids aside from cannabis. Nonopioid medications appear to have similar efficacy, and behavioral, voluntary, slow-tapering interventions can improve function and well-being while reducing pain.

For the opioid addiction crisis, clearly efficacious medications such as methadone and buprenorphine are underprescribed. Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.

NBC News has this new article, headlined "CBD goes mainstream as bars and coffee shops add weed-related drinks to menus," that is worth a read, and I especially liked its closing paragraph. Here are excerpts:

Coffee. Cocktails. Lotion. Dog treats. You name it, CBD is probably in it.

CBD, short for cannabidiol, is a compound found in the cannabis plant. It promises to deliver the calming benefits of marijuana without the high that comes from THC. Companies are adding CBD to just about everything — a trend set to accelerate as regulations ease and consumer interest grows.

Most CBD is now federally legal thanks to the farm bill President Donald Trump signed in December. Companies still aren't supposed to add CBD to food, drinks and dietary supplements, but many are doing it anyway. The Food and Drug Administration has said it plans to continue enforcing this ban but will also look into creating a pathway for such products to legally enter the market.

Some users swear by it, saying it relieves their anxiety, helps them sleep and eases their pain. And forget stoner stereotypes when thinking about CBD. Moms and even pets are experimenting with it. One research firm, Brightfield Group, expects the CBD market to reach $22 billion by 2022.

However, most of our current understanding of CBD is anecdotal — not proven through scientific studies. And because CBD products aren't yet regulated, the quality can vary widely. "There's a lot of interest and excitement, for good reason, but I think people are pushing it too hard, too fast and are overgeneralizing things," said Ryan Vandrey, a professor at Johns Hopkins who studies the behavioral pharmacology of cannabis.

We don't know what exactly CBD interacts with in the brain or the body, but researchers do know that CBD tends to turn down abnormal signaling in the brain, said Ken Mackie, a psychological and brain sciences professor at Indiana University. That's why CBD may help with epilepsy, anxiety and sleep. CBD and other cannabis compounds tweak systems in the body, a process he compares to lowering the volume. Other compounds, like opioids, ketamine and nicotine, simply turn them on and off.

There isn't much clinical research on the safety and efficacy of CBD. Studying cannabis has been challenging because it's technically illegal under federal law, meaning researchers must overcome a number of hurdles in order to study it. We don't know anything about indications like sleep, anxiety or pain, Vandrey said.

We do know it's safe and effective in treating seizures in children with Lennox-Gastaut syndrome or Dravet syndrome. GW Pharma studied its CBD-derived drug, Epidiolex, in numerous clinical trials. After reviewing the company's science, the Food and Drug Administration approved Epidiolex in June.

The lack of clinical evidence hasn't stopped consumers from trying it — and raving about it. "It's always nice to have strong proof in placebo controlled trials, but if someone's taking a drug and feeling any benefit, more power to them," Mackie said....

The farm bill signed in December legalized hemp. Most CBD hitting shelves is derived from the hemp plant, which contains less than 0.3 percent THC, the psychoactive chemical in weed. Hemp's close cousin, marijuana, can contain upwards of 10 percent THC. So you can't get high from CBD products if the proper dosage is followed, but the industry isn't regulated on a federal level so the amount of THC can vary.

Doses can vary, too. Some shops recommend six milligrams of CBD when taken as a tincture or added to food. Others recommend at least 30. Again, since there isn't much clinical research on CBD, most of the recommendations are based on trial and error.

As more people dabble with CBD, more people are following the money, worrying some that bad products will enter the market and taint CBD's allure. Or worse, harm consumers. "There does need to be some sort of regulatory framework for overall product safety and to protect the customer from purchasing products that contain false advertisements or make unsubstantiated claims," said Pamela Hadfield, co-founder of HelloMD, a medical cannabis company, while cautioning against strict regulations that would be "too difficult for most manufacturers to comply."

Joe Masse, beverage director at The Woodstock bar, added a CBD cocktail to the menu in September. Called The White Rabbit, the drink is made with Bombay Dry Gin, sage simple syrup, honey, fresh lemon juice and 1 milligram of CBD oil.... "It's trendy right now, so I don't know how it will be in six months when we redo the menu," Masse said. "A year ago, activated charcoal was popular and now you can't find it anywhere."

Because I am not hip enough to know that "sctivated charcoal" was once, and now is no longer, a big deal, I am not the right person to be predicting the trend lines on the CBD trend. But I do know how important and likely unpredictable it will be to see the FDA and/or state regulatory players take on CBD products and marketing in the wake of the new Farm Bill. Just another important front to watch in the coming months and years and marijuana products and industry players continue to emerge from prohibition's shadow.

Here is a silly trivia question: How did some people in Ohio celebrate the 100-year anniversary of the ratification of the alcohol prohibition amendment?

Answer: By finally being able to purchase medical marijuana in the state legally.

Remarkably, it has taken more than 30 months form the Buckeye State to go from the passage of a medical marijuana law to the opening up of the first legal dispensaries. And, not surprisingly, this new NBC News piece is already asking whether this development will help with the state's opioid problems. Here are excerpts:

Leaning on her cane, Joan Caleodis stepped gingerly into history on Wednesday as one of the first people to legally purchase medical marijuana in the state of Ohio.

Caleodis, who is 55 and suffers from multiple sclerosis, paid $150 for three containers, each holding 2.83 grams of dried cannabis flowers, at the CY + Dispensary in the town of Wintersville.

“I’m feeling ecstatic,” Caleodis told reporters as other pain sufferers waiting in line applauded. “The patients no longer have to wait for relief. We can get rid of this opioid issue we have in this country.” Caleodis said she felt even better when she got home and tried out her purchase. “I was curious and I am very happy with the quality,” she told NBC News. “Some days are worse than others, but I am pretty much in constant pain and right now I am not.”

A former state worker who went on disability after 27 years on the job, Caleodis said she was prescribed opioids for pain after she was diagnosed with multiple sclerosis more than eight years ago. “I found myself taking double the amount prescribed and told myself, ‘I’m not going that route’,” she said. “This is definitely better.”

While medical marijuana is now available in the Buckeye State, it is unclear if the change will put a dent into the state's opioid epidemic. Ohio is one of “the top five states with the highest rates for opioid-related overdose deaths,” according to the National Institute on Drug Abuse.

Medical marijuana dispensaries are regulated in Ohio by the state Board of Pharmacy. When asked if the state views legal pot as a potential weapon in the battle against the deadly opioid epidemic, a Board spokesman replied, “The state has no official policy on this.”

The same question was posed to newly-installed Gov. Mike DeWine, who as attorney general sued the pharmaceutical companies for flooding his state with prescription painkillers. His team referred a reporter to the state Board of Pharmacy....

“There’s some suggestive evidence that marijuana may help to reduce opioid use,” Dr. Caleb Alexander, co-founder of the Center for Drug Safety and Effectivenesss at the Bloomberg School posted. “There’s also some evidence to the contrary.”

Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corporation said in the same forum that she was in favor of expanding medical marijuana programs, but added, “I do not believe that doing so will substantially impact the opioid epidemic. “

“Most people substituting cannabis for opioids are not using either drug medicinally,” she wrote. “Moreover, research does not suggest that cannabis is a substitute for heroin or fentanyl, the major drivers of the epidemic today.”

Mark Parrino of the American Association for the Treatment of Opioid Dependence said, “It is counterintuitive to advocate for the legalization of marijuana while our nation is struggling with an opioid use disorder epidemic.” “While medical use of marijuana may be beneficial in some cases, I do not think that it is reasonable to promote marijuana as a positive medical treatment,” he wrote.

Caleodis said anyone who thinks marijuana doesn’t help should take a walk in her shoes. She said she has used other “black market” cannabis products to easy her anguish over the years. “My symptoms are always there, I feel a burning in my feet just about all the time,” she said. “And at night it is way worse. Sometimes I just can’t sleep. But tonight I think I will.”

The title of this post is the title of this great new book chapter authored by Lewis Grossman now available via SSRN. Here is its abstract:

The struggle for access to medical marijuana differs from most other battles for therapeutic freedom in American history because marijuana also has a popular, though controversial, nontherapeutic use — delivery of a recreational high. After considering struggles over the medical use of alcohol during prohibition as a precedent, this chapter relates the history of medical marijuana use and regulation in the United States. The bulk of the chapter focuses on the medical marijuana movement from the 1970s to present. This campaign has been one of the prime examples of a successful extrajudicial social movement for freedom of therapeutic choice. With the exception of a single promising decision in 1975, courts have uniformly rejected arguments for medical marijuana access. But the 1996 passage of Proposition 215 in California triggered a tremendous wave of state measures legalizing medical cannabis, as well as a dramatic change in American attitudes about the issue.

The chapter recounts this history in light of the special legal, political, and rhetorical challenges medical cannabis advocates have faced. First, many officials have opposed the legalization of medical marijuana, regardless of whether it offers therapeutic benefits, because of the public health harms and moral degradation they associate with the use of pot. Second, marijuana’s designation as a Schedule I substance under the Controlled Substances Act of 1970, and the DEA’s rejection of multiple citizen petitions to reclassify it, has placed extremely high obstacles in the way of researchers interested in scientifically assessing marijuana’s therapeutic efficacy. Third, federal government policies have lagged behind public preference and state law. Finally, medical marijuana supporters have had to negotiate an invaluable but fraught relationship with advocates for comprehensive marijuana legalization. The perspectives and goals of these two groups have overlapped and conflicted in fascinating and unexpected ways.

The debate over the relationship between the opioid crisis and marijuana reforms is so very interesting and, of course, so very important. Advocates for and against marijuana reform seem ever eager to leverage the opioid crisis (and everything else) to support their prior conclusions about the virtues or vices of marijuana reform. Against this backdrop, I think information from non-partisans is especially valuable, and thus I was pleased to see this notable new report from the Maryland Medical Cannabis Commission titled "Treatment of Opioid Use Disorder with Medical Cannabis." I recommend the full report, which mostly just reports on the state of the law in many jurisdictions and research on these topics. Here are excerpts:

Since 2016, at least nine states have considered legislation or regulations to allow medical cannabis as an opioid replacement therapy to help ease withdrawal symptoms and aid in relapse prevention.... In 2018, Pennsylvania, New Jersey, and New York became the first states to expressly allow medical cannabis for the treatment of OUD. Each state permits the use of medical cannabis to treat OUD, but with significant restrictions....

From 2016-2018, at least seven state legislatures considered bills that would expressly add OUD to the list of medical cannabis qualifying conditions. Of these, the majority rejected the legislation seeking to add OUD to the list of qualifying conditions. [T]hree states – Hawaii, Maine, and New Mexico – passed legislation authorizing the use of medical cannabis to treat OUD; however, the State’s Governor vetoed the legislation in each instance following significant pressure from health care providers, health care organizations, and addiction specialists....

Data suggest that cannabis legalization reduces prescription opioid use by serving as an alternative pain treatment. Medical cannabis laws may also have downstream policy effects on reducing opioid-related hospitalizations, overdose deaths, and traffic fatalities. The following section examines existing literature on the association between medical cannabis and opioid use, including as a treatment for opioid use disorder....

[But] a study was published in the “To the Editor” section of JAMA Internal Medicine in September 2018, which found that the opioid-related overdose death rate was accelerating in states where medical and/or adult use cannabis laws had been implemented. Moreover, the death rate surpassed that of nonlegalizing states. The study reviewed opioid-related overdose death data from 2010 to 2016, and determined that the age-adjusted death rate was higher in states with cannabis legalization and that the age-adjusted death rate was increasing at a faster rate than in non-legalizing states. While several researchers have challenged the methodology of this study – including the inaccurate assessment of states that have legalized medical and adultuse cannabis – the results call attention to the need for further investigation of the association between cannabis legalization and opioid-related overdose deaths....

In December 2018, the Commission received two petitions requesting the addition of OUD to the list of medical cannabis qualifying conditions. If the Commission determines that either or both of these petitions are “facially substantial” then it must conduct a public hearing within the next 12 months to evaluate whether the medical condition or disease should be included in the list of qualifying conditions. The Commission’s Research Committee, which includes two physicians, a scientist, addiction specialist, and horticulturist, is currently evaluating the petitions to determine whether they are facially substantial and require a public hearing. The Commission will provide the General Assembly with updates on the status of the OUD petitions, including information on any public hearings to consider adding OUD as a qualifying medical condition.

The holiday last week and busy times at the end of a semester (and lots of sentencing reform activity) has put a crimp in my blogging lately. But this slow down on the blog does not reflect a slow down in marijuana reform news, and so I will try to catch up here with a few headlines and links to stories that highlight, yet again, that it is always a busy season in the arena of marijuana reform:

As reported in this local article, this week "a Franklin County judge threw out a state law requiring that at least 15 percent of cultivation licenses go to businesses owned or controlled by African Americans, Asians, American Indians, Hispanics or Latinos." Here is more on the ruling and reactions thereto:

The Ohio Department of Commerce, the state agency that awards cultivation licenses, will have to decide whether to comply with Franklin County Common Pleas Judge Charles A. Schneider’s Thursday decision and award provisional cultivation licenses to white-owned businesses that scored higher in the review process -- including Greenleaf Gardens, LLC, which challenged the constitutionality of the law in court. Greenleaf Gardens had planned for a large-scale medical marijuana grow operation in Geauga County.

The state could also decide whether to throw out previously awarded licenses to two minority-owned and -controlled businesses that scored lower, although Greenleaf’s attorney wrote in court filings the company did not want that. Commerce can also appeal the decision to a higher court. “We are reviewing the judge’s ruling and considering next steps,” said Kerry Francis, the Department of Commerce’s spokeswoman.

Schneider’s decision only affects part of Ohio’s medical marijuana law, and leaves the rest of it intact.

Greenleaf CEO David Neundorfer said he’s pleased with the court’s ruling. The company has licenses in other parts of the nascent medical marijuana program....

Greenleaf Gardens sued after the Department of Commerce announced recipients of the provisional cultivation licenses, nearly a year ago. It received the 12th highest score among cultivation applicants but did not receive one of the 12 licenses for a large-scale cultivator. The department instead gave licenses to two lower scoring applicants, Parma Wellness Center, LLC and Harvest Grows, LLC.

The Department of Commerce argued it was following Ohio’s medical marijuana law, including provisions the Ohio General Assembly created that not less than 15 percent of cultivator, processor or laboratory licenses be given to entities owned and controlled by Ohio residents who are members of an economically disadvantaged group. The law lists each racial and ethnic group and states that “owned and controlled” means at least 51 percent of the business or business stock is owned by people in the groups....

Harvest Grows argued in a brief that Ohio for nearly 40 years has remedied discrimination in government licensing through set-asides for minority businesses. Hundreds of studies have shown that without the set-asides, “government funds have been, and will be, used in a discriminatory fashion.” It noted that blacks are more than four times more likely than non-minorities to be arrested for marijuana possession, even though studies show marijuana use is almost the same. “The legislature knew about these issues when it created the 15 percent set-aside at issue in this case," Harvest Grows wrote.

The judge, however, sided with Greenleaf Gardens. Schneider relied on a 2003 U.S. Supreme Court case that said a way to examine these issues is by looking at whether there is a compelling governmental interest for racial classification and whether the set-aside is narrowly tailored to achieve the goal.

Schneider wrote that there is a lack of “sufficient evidence of a government compelling interest" because the only evidence the legislature considered were marijuana crime arrests. He wrote that the state didn’t look at arrest rates for racial groups outside of blacks and Latinos, and discrimination in arrest rates and marijuana businesses are different....

The marijuana law’s provisions were different from specifications in Ohio’s Minority Business Enterprise Program, he concluded. And other states' encouragement of minority businesses in their medical marijuana programs were different from Ohio’s, such as Illinois giving minority businesses more points during scoring, not after scoring.

“If the legislature sought to rectify the elevated arrest rates for African Americans and Latinos/Hispanics possessing marijuana, the correction should have been giving preference to those companies owned by former arrestees and convicts, not a range of economically disadvantaged individuals, including preferences for unrelated races like Native Americans and Asians,” he wrote.

The Hill has this extended (and not surprising) article about where the marijuana reform movement is planning to go for the next round of ballot initiatives. The piece is headlined "Marijuana backers plot ambitious campaign," and here are excerpts:

Advocates of legalizing medical and recreational marijuana are planning a wave of new ballot measures in coming years few years, buoyed by wins scored this year's midterm elections in swing and conservative states.

Supporters say they are likely to field measures in states like Ohio and Arizona in 2020, and potentially in Florida and North Dakota. They say plans are underway for initiatives to legalize medical marijuana in Mississippi, Nebraska and South Dakota.

“2020 provides an opportunity to run medical marijuana and legalization campaigns across the country. Typically, presidential elections offer better turnout and a more supportive electorate,” said Matt Schweich, deputy director of the Marijuana Policy Project. “I’d be surprised if there weren’t a large number of initiatives being run — statutory, constitutional, legalization, medical marijuana. It’s going to be a big opportunity for our movement to build momentum.”...

“We won our first state outside of the coasts, and I think there’s a strong feeling that we’re sort of on the downhill of the tipping point,” said one strategist who has worked on legalization measures, who asked for anonymity to describe future plans....

The strategist said legalization backers have settled on a reliable formula that has generated success at the ballot box. The template includes language allowing adults to grow a small number of marijuana plants in their own home, banning advertising aimed at children and controlling potency of products like edibles that make it to market.

The measures [that failed previously] in North Dakota and Ohio did not closely follow that template; the Ohio measure, which did not earn support from the largest groups that back legalization campaigns, went so far as to parade a marijuana leaf mascot — named Bud — around campaign events before it went down in a crushing defeat.

Opponents of marijuana legalization said they have turned their focus to another provision typically found in successful ballot measures, one that allows counties and municipalities to ban pot shops even if recreational marijuana is legal statewide. “In all states with legalization, the majority of towns and cities that have voted have banned pot shops,” said Kevin Sabet, who heads the drug policy group Smart Approaches to Marijuana, which opposes legalization. “We … think we can get a majority of counties to opt out of pot shops in Michigan.”

A Pew Research Center survey conducted in October showed 62 percent favor legalization — including majorities among Millennials, members of Generation X and the Baby Boomer generation. Drug legalization is one of the few issues where men take a more liberal stand than women. The Pew Research survey showed 68 percent of men, and just 56 percent of women, support legal pot.

The Utah measure that passed this year is especially notable, Schweich said, because the Republican-dominated state legislature is now likely to take up its own medical marijuana measure. That measure will likely be more conservative than the ballot proposition voters approved, but it will still mark the first time a conservative legislature has approved marijuana use. “You’re going to see a very conservative state adopt, via its legislature, a medical marijuana law,” he said. “We’ve really showed that any state, no matter how socially conservative it might be, can have medical marijuana.”

The legislative action in Utah is a prelude of what marijuana legalization backers hope becomes the next front in their fight. Not every state allows citizens to change laws via ballot measure; in some states, any change will be up to the legislature.

Two Democratic governors have indicated they would support legalization if the legislature forwards a bill to their desks. New Jersey Gov. Phil Murphy (D) ran into opposition from some Democratic legislators during his first session in office but Illinois Gov.-elect J.B. Pritzker (D) has said he supports legalization.

Tom Angell has this new Forbes piece under the headline "Marijuana Won The Midterm Elections." His accounting of marijuana's victory goes beyond just the statewide ballot initiatives, and here are excerpts (with links from the original and my highlighting of state names):

While North Dakota's long-shot marijuana legalization measure failed, cannabis also scored a number of big victories when it came to the results of candidate races. When new pro-legalization governors take their seats next year, marijuana bills in several states will have a good chance of being signed into law.

In Illinois, Democrat J.B. Pritzker won the governor's race after making marijuana legalization a centerpiece of his campaign. "We can begin by immediately removing one area of racial injustice in our criminal justice system," he said during his primary night victory speech earlier this year. "Let's legalize, tax and regulate marijuana."

Minnesota Gov.-elect Tim Walz (D) wants to "replace the current failed policy with one that creates tax revenue, grows jobs, builds opportunities for Minnesotans, protects Minnesota kids, and trusts adults to make personal decisions based on their personal freedoms."

Michigan voters who supported the state's marijuana legalization measure will have an ally in the incoming governor, Gretchen Whitmer (D), who supported the initiative and is expected to implement it in accordance with the will of the people. She has called cannabis an "exit drug" away from opioids

In New Mexico, Michelle Lujan Grisham (D), who won the governor's race, said legalizing marijuana will bring “hundreds of millions of dollars to New Mexico’s economy."

In New York, while easily reelected Gov Andrew Cuomo (D) had previously expressed opposition to legalization, he more recently empaneled a working group to draft legislation to end cannabis prohibition that the legislature can consider in 2019, a prospect whose chances just got a lot better in light of the fact that Democrats took control of the state's Senate.

In Wisconsin, Democrat Tony Evers supports decriminalizing marijuana and allowing medical cannabis, and says he wants to put a full marijuana legalization question before voters to decide. He ousted incumbent Gov. Scott Walker (R) on Tuesday.

States that already have legalization elected new governors who have been vocal supporters and will likely defend their local laws from potential federal interference. California's Gavin Newsom, Colorado's Jared Polis, Maine's Janet Mills and Nevada's Steve Sisolak, all Democrats, fit that bill. Oregon Gov. Kate Brown (D), also a legalization supporter, was reelected in her state, which ended prohibition in 2014.

Speaking of the federal government, when it comes to congressional races, one of the main impediments to cannabis reform on Capitol Hill won't be around in 2019. Rep. Pete Sessions (R-TX), who as chairman of the House Rules Committee, has systematically blocked every single proposed marijuana amendment from reaching a floor vote this Congress, is now out of a job after having lost his reelection bid to Democrat Colin Allred.

And the fact that the Democrats, who have been much more likely than Republicans to support cannabis reform legislation than GOP members, retook control of the chamber means that the chances of ending federal prohibition sooner rather than later just got a lot better. Last month, Rep. Earl Blumenauer (D-OR) published what he called a "Blueprint to Legalize Marijuana" in which he laid out a detailed, step-by-step plan for Democrats to enact the end of federal cannabis prohibition in 2019. It's not clear whether Democratic leaders will embrace the idea, but a look at polling on the issue should give them the sense that marijuana reform is a popular issue with bipartisan support....

That said, while Senate Majority Leader Mitch McConnell (R-KY) has championed legalizing hemp, he does not support broader marijuana law reform and seems unlikely to bring far-reaching cannabis bills to a vote without substantial pressure.

But President Trump earlier this year voiced support for pending legislation that would respect the right of states to implement their own marijuana laws. If Democrats pass that bill or similar proposals out of the House, the president's support could be enough to get it through the Senate, where a number of GOP members have already endorsed ending federal prohibition.

In recent history, elections in 2012 and 2016 have been arguably the most consequential for the modern marijuana reform movement. But every election cycle is important in its own way, and the 2018 season is no different as three of four statewide marijuana initiatives appear to have passed on this election night (and this follows a medical marijuana initiative passing in Oklahoma in mid-2018). Specifically:

It has been a big year for marijuana policy in North America. Mexico’s supreme court overturned pot prohibition last week, while Canada’s recreational marijuana market officially opened its doors in October.

Stateside, recreational marijuana use became legal in Vermont on July 1, Oklahoma voters approved one of the country’s most progressive medical marijuana bills in June, the New York Department of Health officially recommended legalization to the governor and the Commonwealth of the Northern Mariana Islands legalized recreational use.

Now, legalization advocates are hoping to build on these successes with a number of statewide ballot measures up for consideration Tuesday, including full recreational legalization in two states and medical marijuana in two more. Here’s a rundown of what the measures say and where the polling on them stands.

Michigan: Recreational use....

North Dakota: Recreational use....

Missouri: Medical use....

Utah: Medical use....

UPDATE: The folks over at Marijuana Majority have this interesting accounting of monies spent in these campaigns under the headline "Marijuana Ballot Initiative Campaigns Raised $12.9 Million, Final Pre-Election Numbers Show." Here is how the piece starts:

2018 has been a banner year for marijuana ballot initiatives. Voters in two states are considering legalizing recreational use, while those in another two states will decide whether to allow medical cannabis.

In the lead-up to the election, committees supporting or opposing these initiatives have raised a total of $12.9 million in cash and in-kind services over the past two years to convince those voters, Marijuana Moment’s analysis of the latest campaign finance records filed the day before Election Day shows.

On the day final ballots are cast and tallied, here’s where funding totals now stand for the various cannabis committees, both pro and con, in the four states considering major modifications to marijuana laws.

The title of this post is the headline of this lengthy new NBC News article, which carries this summary subhead: "Four states have marijuana measures on the ballot in November, and a Democratic Congress could make it easier for more states to relax drug laws." With exactly two weeks until Election Day 2018, I like the phrase "marijuana midterms," and here are excerpts from the lengthy press piece:

As polls show record support for marijuana legalization, advocates say the midterm elections could mark the point of no return for a movement that has been gathering steam for years. "The train has left the station," said Rep. Earl Blumenauer, D-Ore., a leading marijuana reform advocate in Congress. "I see all the pieces coming together... It's the same arc we saw two generations ago with the prohibitions of alcohol."

Voters in four states will weigh in on ballot initiatives to legalize weed for recreational or medical use next month, while voters everywhere will consider giving more power to Democrats, who have increasingly campaigned on marijuana legalization and are likely to advance legislation on the issue if they win back power in Congress and state capitals.... Politically, the issue has gone from a risible sideshow to a mainstream plank with implications for racial justice and billions of dollars in tax revenue. "Politicians embraced it because it's actually good politics,” said Blumenauer. “They can read the polls.”...

But opponents say advocates are ignoring the backlash that rapid legalization has created, including from some surprising corners, like the Detroit chapter of the NAACP, which is set to announce Tuesday its opposition to a ballot measure that would legalize marijuana in Michigan, the most significant of this year's referendums. Michigan already has a robust medical marijuana industry, but voters could decide to fully legalize the drug for recreational use on Nov. 6. A recent survey commissioned by The Detroit Free Press found 55 percent of voters supported the measure, compared to 41 percent who opposed it.

Meanwhile, North Dakota voters will also have a chance to legalize recreational marijuana in one of the most conservative states in the country, two years after 64 percent of voters approved its medical use during the 2016 election. Advocates are less hopeful about their prospects this year, though a pro-legalization group released a poll this weekend claiming a narrow 51 percent of likely voters approve of the measure.

Utah, a deep red state with some of the strictest alcohol rules in the country, is considering a medical marijuana initiative, which polls suggest is favored to succeed, even though most of the state’s political and religious leaders oppose it.

At the same time, Missouri voters will consider three separate and competing medical marijuana ballot initiatives. The situation has frustrated advocates and could confuse voters, especially because it's unclear what will happen if they approve more than one next month.

Meanwhile, Vermont's state legislature earlier this year legalized cannabis, though not for commercial sale, and New York and New Jersey could be next, as lawmakers in both states are actively considering the issue....

Progressive Democrats like Florida gubernatorial candidate Andrew Gillum and Texas Senate candidate Rep. Beto O’Rourke, D-Texas, have adopted marijuana legalization as a central plank of their campaigns by tying the issue to criminal justice reform, citing the disproportionate number of African-Americans arrested for the drug even though usage is common among whites. In one of the biggest applause lines of his stump speech, O’Rourke — a longtime advocate of marijuana reform dating back to his days on the El Paso City Council — asks supporters who will be the last person of color incarcerated for possessing something that is now legal for medical use in a majority of states.

But a growing number of more mainstream Democrats have adopted the policy too, like J.B. Pritzker, the billionaire hotel magnate running for governor of Illinois, and Michigan gubernatorial candidate Gretchen Whitmer, who beat a progressive Bernie Sanders-style challenger in the Democratic primary. “Democrats have really jumped on this as a way of galvanizing their voters,” said Michael Collins, the interim director of the pro-legalization group Drug Policy Action. “If you're on the more moderate side of the party and you want to show your progressive bona fides, you go to marijuana, because it's not as controversial an issue as, say eliminating ICE,” the Immigrations and Customs Enforcement agency....

But Kevin Sabet, a former adviser to the Obama administration on drug policy who runs a group that opposes marijuana legalization, says advocates are overstating the inevitability of their side. “I don't think this is a done deal at all,” he said, noting that his group, Smart Approaches to Marijuana, has raised more money this year than any year in its history. “Ironically, the more legalization rolls out, as recklessly as it is, the more support we get.” Polls showing sky-high support for legalization can be misleading, Sabet argues, because they use vague wording that can lead respondents to conflate decriminalization with a full-blown recreational system that allows for storefront dispensaries.

Some of the most vocal opposition, he said, has come from African-American organizations, who express concern that the commercialization of the marijuana industry has primarily benefited white entrepreneurs even though communities of color have borne the brunt of the drug war. "This really isn't about social justice, it's about a few rich white guys getting rich," Sabet said, noting that the black caucus in the New Jersey state legislature has helped stall Murphy's legalization effort in New Jersey.

Proponents acknowledge the racial disparities in the marijuana industry, and some, like Maryland Democratic gubernatorial candidate Ben Jealous, the former head of the NAACP, has advocated a legalization regime that would benefit black and brown weed entrepreneurs.

Either way, if Democrats win back the House, advocates say Congress could advance a number of reform bills that have been blocked by the Republican majority. Some, like a bill to exempt states that have legalized marijuana from federal restrictions and another to allow marijuana businesses to use banks, have numerous Republican co-sponsors and could pass both chambers of Congress today — if only leaders allowed lawmakers to vote on them, advocates say.

The title of this post is my weak attempt to make a play on the phrase "Go West, young man" to capture Manifest Destiny concepts combined now with this new AP article about marijuana reform efforts this election year. The AP piece is headlined "Marijuana backers look for Midwest breakthrough in November," and here are excerpts:

Backers of broad marijuana legalization are looking to break through a geographic barrier in November and get their first foothold in the Midwest after a string of election victories in Northeastern and Western states.

Michigan and North Dakota, where voters previously authorized medical marijuana, will decide if the drug should be legal for any adult 21 and older. They would become the 10th and 11th states to legalize so-called recreational marijuana since 2012, lightning speed in political terms.

Meantime, Missouri and Utah will weigh medical marijuana, which is permitted in 31 states after voters in conservative Oklahoma approved such use in June. Even if Utah’s initiative is defeated, a compromise reached last week between advocates and opponents including the Mormon church would have the Legislature legalize medical marijuana.

“We’ve kind of reached a critical mass of acceptance,” said Rebecca Haffajee, a University of Michigan assistant professor of health management and policy. She said the country may be at a “breaking point” where change is inevitable at the federal level because so many states are in conflict with U.S. policy that treats marijuana as a controlled substance like heroin. “Generally, people either find a therapeutic benefit or enjoy the substance and want to do so without the fear of being a criminal for using it,” Haffajee said....

In Michigan, surveys show the public’s receptiveness to marijuana legalization tracks similarly with nationwide polling that finds about 60 percent support, according to Gallup and the Pew Research Center.

The Washington-based Marijuana Policy Project was the driving force behind successful legalization initiatives in other states and has given at least $444,000 for the Michigan ballot drive. “The electorate is recognizing that prohibition doesn’t work. There’s also a growing societal acceptance of marijuana use on a personal level,” said Matthew Schweich, the project’s deputy director. “Our culture has already legalized marijuana. Now it’s a question of, ‘How quickly will the laws catch up?’” added Schweich, also the campaign director for the Michigan legalization effort, known as the Coalition to Regulate Marijuana Like Alcohol.

Midwest voters have considered recreational legalization just once before, in 2015, when Ohio overwhelmingly rejected it. Supporters said the result was more back lash against allowing only certain private investors to control growing facilities than opposition to marijuana.

Proponents of Michigan’s measure say it would align with a new, strong regulatory system for medical marijuana businesses and add roughly $130 million annually in tax revenue, specifically for road repairs, schools and municipalities. Military veterans and retired police officers are among those backing legalization in online ads that were launched Tuesday.

Critics say the Michigan proposal is out of step and cite provisions allowing a possession limit of 2.5 ounces (71 grams) that is higher than many other states and a 16 percent tax rate that is lower. Opponents include chambers of commerce and law enforcement groups along with doctors, the Catholic Church and organizations fighting substance abuse....

In North Dakota, legalization faces an uphill battle. No significant outside supporters have financed the effort, which comes as the state still is setting up a medical marijuana system voters approved by a wide margin two years ago.

The medical marijuana campaign in predominantly Mormon Utah, which has received $293,000 from the Marijuana Policy Project, was jolted last week when Gov. Gary Herbert said he will call lawmakers into a special postelection session to pass a compromise deal into law regardless of how the public vote goes.

Medical marijuana also is on the ballot in Missouri and while the concept has significant support, voters may be confused by its ballot presentation. Supporters gathered enough signatures to place three initiatives before voters. Two would change the state constitution; the third would amend state law. If all three pass, constitutional amendments take precedence over state law, and whichever amendment receives the most votes would overrule the other.

An organizer of one amendment, physician and attorney Brad Bradshaw, said it is unclear if having three initiatives could split supporters so much that some or all of the proposals fail. “A lot of people don’t really even have this on the radar at this point,” he said. “They’re going to walk into the booth to vote and they’re going to see all three of these and say, ‘What the heck?’ You just don’t know how it’s going to play out.”

Though some may tire of the talk of "laboratories of democracy" in the context of marijuana reform, I never tire noticing all the different ways state-level reform efforts are producing different approaches to marijuana laws and policies. And, as explained in this new local piece, headlined "Utah could become the guinea pig for state distribution of medical marijuana," a notable state out west is working toward a novel social and economic experimental approach to marijuana reform. Here are the details:

The medical marijuana agreement that has brought together warring factions in the Proposition 2 debate could make Utah a national test case — the state itself would distribute the cannabis. Sure, other governments have mulled such a system, but they’ve generally shied away from direct involvement in dispensing a substance illegal under federal law, said Karen O’Keefe, state policies director for the Marijuana Policy Project....

Gov. Gary Herbert, legislative leaders and advocates unveiled the proposed legislation Thursday that Utah lawmakers are expected to take up during a November special session. Herbert described it as a step toward establishing a medical marijuana program that Prop 2 opponents, such as The Church of Jesus Christ of Latter-day Saints, could stomach and pledged to put it before lawmakers next month whether or not the ballot initiative passes.

The consensus plan would create a centralized state pharmacy that would package individual medical cannabis orders and ship them to a local health department for pickup by patients who qualify. Up to five private “medical cannabis pharmacies” would also be allowed under the legislation, but the state-run system would act as an alternative for rural residents who live far from these locations, Sen. Evan Vickers, R-Cedar City, said. “Is it unique? Yeah, it’s definitely a unique model,” he said, “and that’s why it could very well become the role model ... for the rest of the country."...

Vickers, who is a pharmacist by profession and helped broker the cannabis accord, said he was comfortable that the state wouldn’t run afoul of federal law by getting involved in the distribution of a Schedule 1 drug. He said he vetted the idea with the Drug Enforcement Administration but wouldn’t disclose who he’d communicated with, saying the conversations were sensitive.

O’Keefe said the Marijuana Policy Project isn’t sure a state-run model will fly in Utah. The closest comparison for it is in Louisiana, where the state designated two public institutions, Louisiana State University and Southern University, as the only legal growers of marijuana plants. The Louisiana program isn’t running yet, she said. But her advocacy group — which has dumped more than $210,000 into the campaign supporting Prop 2 — is satisfied that if Utah’s centralized system fails, the private cannabis pharmacies will keep patients supplied....

Connor Boyack, founder of the libertarian Libertas Institute, said the state-run system was a hotly debated element in the medical cannabis plan. His group was unwilling to rely on the central fill pharmacy alone and insisted the bill allow private pharmacies as a backup. “We don’t have high hopes for [the state-run system]," he said, “but to be fair and in good faith, we’re saying, go for it.”

The title of this post is the the of this new paper recently posted to SSRN and authored by Matt Lamkin. Here is its abstract:

From the opioid epidemic and medical marijuana to abortion restrictions and physician-assisted suicide, disputes over the proper uses of medicine loom large in American life. Nowhere is this conflict more apparent than in federal drug control policy, which is premised on a clear distinction between legitimate “medical” uses and illicit “abuse.” Yet the Controlled Substances Act defines neither of these foundational concepts . While it is tempting to imagine medicine’s scope is limited to treating or preventing disease – rendering nontherapeutic drug use “abuse” – in fact medical practice has always included interventions that are not aimed at healing. This trend has only accelerated as medical practice has become increasingly consumer-oriented. From Adderall to Xanax, patients now routinely seek prescriptions not to treat diagnosable illnesses, but to relieve stress, improve productivity, and otherwise enhance quality of life.

As physicians increasingly prescribe psychoactive drugs to help healthy people obtain desirable mental states, distinguishing legitimate drug use from recreational abuse becomes ever more difficult. Having failed to acknowledge this challenge, the DEA, courts, and scholars have not offered a principled way to make this distinction, rendering drug control policy increasingly incoherent. As a result, doctors face criminal prosecution without clear standards governing prescribing, potentially valuable interventions are arbitrarily barred from the market, and millions seek the benefits of drugs without professional medical guidance to mitigate their risks.

Rather than being limited to therapeutic aims, medicine is better understood as the application of a loosely-defined set of knowledge and interventions that the law entrusts to specific professionals, with accompanying duties to use these tools to benefit patients. Medical practice includes treating and preventing illnesses, but can also include enhancing social and cognitive functioning and promoting the well-being of people whose challenges do not rise to the level of disorders. Discarding a narrow conception of medicine does not require abandoning the enforcement of drug laws or the policing of doctors. But acknowledging the expansiveness of medicine’s domain does argue for clarifying the scope of physicians’ criminal liability and pursuing new strategies for harnessing drugs’ benefits while mitigating their risks.

I could not resist spotlighting this new local article about the slow roll-out of Ohio's medical marijuana program due to its use of a great quote in its headline, "'Cannabis regulated like plutonium': Security measures causing delays in marijuana launch date." Here is some context for the quote:

Ohio's Medical Marijuana program was originally supposed to launch on Sept. 8. For months, it's been clear that delays with licensing and construction for the new facilities meant patients wouldn't be able to get medical products produced in Ohio until months after the initial start date, potentially as late as early 2019.

For an industry that's planning to be the business of the future, required security measures sound like they're from an old-fashioned action movie. Some of the basic procedures medical marijuana companies will have to follow include "unmarked cars, travel point A to point B, randomized routes, manifests before and after delivery," explained Frantz Ward LLP Attorney Tom Haren....

"I think that cannabis is basically regulated like plutonium," said Cleveland School of Cannabis Dean of Instruction and Student Success Jacob Wagner. He says plants are tracked "from seed to sale," making sure nothing gets diverted to the black market. When his school's students graduate and become medical marijuana industry employees, they'll wear state-required badges, and their facilities will be watched around the clock through redundant security systems, accessible to regulators in Columbus.

"It's designed to also make sure that every product is tested, every product is properly packaged and properly labeled before it reaches the end consumer, the patient," said Wagner.

"The worst thing for the program would be some type of criminal activity of some kind of adulterated product making its way into the market and into the hands of the patient," said Haren.

The question in the title of this post was my first reaction to the latest reports on the latest states to expand access to medical marijuana. This piece from Connecticut on this front is headlined "State Approves Use Of Medical Marijuana For Stubborn Headaches, 7 Other Conditions," and here are the basics:

Medical marijuana may now be prescribed in Connecticut to treat medication-resistant headaches, severe rheumatoid arthritis and several other new conditions, the Department of Consumer Protection announced Tuesday.

The state legislature’s Regulation Review Committee has updated the state’s medical marijuana program regulations to include eight new conditions for adults and two new conditions for patients under 18.

Today, also brings this similar news from Illinois, under the headline "Rauner signs medical marijuana expansion bill allowing drug as painkiller alternative," starting this way:

A measure that could dramatically expand access to medical marijuana in Illinois — making it available as an opioid painkiller replacement and easing the application process for all who qualify — was signed into law by Gov. Bruce Rauner on Tuesday....

No longer will any applicants have to be fingerprinted and undergo criminal background checks. And those who complete an online application with a doctor’s authorization will get a provisional registration to buy medical cannabis while they wait for state officials to make a final review of their request.

My sense is that this is a common reality that has found expression perhaps multiple time in multiple states: over time, states add qualifying conditions or reduce restriction on access to medical marijuana. I suspect someone somewhere is tracking these developments nationwide, and I think the pace and scope of amendments to state medical marijuana regimes would tell an interesting and significant modern reform story.

The title of this post is the title of this notable new research article forthcoming in the October 2018 issue of the International Journal of Drug Policy. Here is its abstract:

Aims

The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.

Design

Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression.

Setting

To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.

Participants

All 50 states and the District of Columbia for the period 1992–2015.

Measurements

Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects.

Findings

Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25–44 (incident rate ratio [IRR], 0.805; 95% CI, .662–.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16–24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25–44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482–.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25–44 than those that did not.

Conclusions

The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25–44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.